NAME:____________________________________________________

ADDRESS:________________________________________________

CITY: ______________________________STATE: ________ ZIP:_____

HOME PHONE:_______________WORK PHONE:_________________

EMAIL ADDRESS:__________________________________________

Membership Categories
Check all that apply

______ New Member ________ Renewal

______ General Membership $ 20 or $57 (3 yr)

______Business Associate $100 or $275 (3 yr)

______ Supporting Bands $50

______ Angel Sponsor $60 *

______ Golden Sponsor $100*
                    *Partially Tax Deductible
 

MAIL TO:

Oregon Bluegrass Association
P.O. Box 1115
Portland, OR  97207

Or email to: lisarem@comcast.net